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Request Services Ltd

Overall: Good read more about inspection ratings

First Floor, 19 Newman lane, Alton, GU34 2QW (01252) 320007

Provided and run by:
Request Services Limited

Important: This service was previously registered at a different address - see old profile

All Inspections

1 September 2020

During an inspection looking at part of the service

About the service

Request Services Ltd is a domiciliary care service providing personal care to 25 people at the time of the inspection. The service provides support to children and adults, some of whom have a learning or physical disability or who may be living with dementia. The service provides critical care packages for people with complex health care needs.

People’s experience of using this service and what we found

People and their relatives were very satisfied overall with the service provided. A relative commented, "We enjoy the relationship with the service" and a person said, "On the whole, I am very impressed."

Staff protected people from the risk of abuse. Staff assessed potential risks to people and ensured their safety was managed. People received their care from sufficient numbers of staff whose suitability for their role had been assessed. Staff received their medicines safely from trained and competent staff. People were protected from the spread of infection.

People’s needs were assessed and delivered in accordance with current guidelines. Staff received appropriate support in their role. Staff ensured people were supported to eat and drink safely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The registered manager created a positive culture which was person centred and focused on achieving good outcomes for people. The registered manager welcomed feedback from people and staff. Staff understood their role and were accountable for their work, as there was a clear governance framework. The provider had processes in place to drive improvements in the service. Staff worked across agencies to provide joined up care for people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection (and update)

The last rating for this service was requires improvement (28 December 2019).

Why we inspected

We carried out an announced comprehensive inspection of this service on 18 and 19 November 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve staff recruitment, staff support and improving care.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe, effective and well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Request Services Ltd on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

18 November 2019

During a routine inspection

About the service

Request Services Ltd is a domiciliary care service providing personal care to 33 people at the time of the inspection. The service provides support to children and adults, some of whom have a learning or physical disability or who may be living with dementia. The service provides both homecare and critical care packages for people with complex health care needs. People receiving the service’s critical care lived with complex health care needs.

People’s experience of using this service and what we found

Processes to monitor the quality of the service provided were not always operated effectively nor were all records either available or fit for purpose. There had been a failure to ensure all staff received sufficient supervision of their work or had updated all of their training at appropriate intervals, to ensure it remained current. Recruitment processes were not sufficiently robust, as a result not all of the required evidence of staff's suitability for their role had been obtained or was available for review.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. We have made a recommendation that the provider reviews the Mental Capacity Act 2005 and guidance about the recording of assessments and decisions.

Potential risks to people had been assessed and processes were in place to protect people from the risk of abuse. Staff were expected to report any incidents, and these were reviewed to ensure any required actions were taken and lessons learnt. People received their medicines as required.

Although the registered manager tried to promote a positive culture focused on meeting people’s needs; they had not effectively assured themselves office staff had always completed delegated tasks to the required standard. People told us communication from office staff was an aspect of the service which could be improved.

People had holistic care plans in place which addressed their physical, mental health and social care needs, including their nutritional needs. Staff supported people to maintain their health and liaised with other agencies as required.

People were well treated and supported by staff who respected their right to be treated with dignity. People were supported by staff to express their views. People had personalised care which respected their needs and choices. Staff would support people with their end of life care where this was their wish.

Processes were in place to seek and act upon people’s feedback on the service. People and their relatives were pleased with the service they received.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was good (published 15 November 2017).

Enforcement

We have identified breaches in relation to governance, staff support, staffing and records at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

25 September 2017

During a routine inspection

Request Services Ltd is a domiciliary care agency and provides personal care and support for people living in their own homes in Hampshire and West Surrey. At the time of our inspection there were 59 people using the service, who had a range of physical and health care needs, supported by 145 staff. The service was providing 3546 hours of care per week. Some people were being supported to live with dementia, whilst others were supported with specific health conditions including epilepsy, diabetes, multiple sclerosis and sensory impairments. The agency also provides what is described as complex care for people who require specific and unique support, for example people with acquired brain injuries.

This announced inspection took place on 25 and 26 September 2017 and 2 October 2017.

At the last inspection the service was rated Good. At this inspection we found the service remained Good.

Staff understood their role and responsibilities to keep people safe from harm. Individual risks were assessed and plans put in place to keep people safe. There was enough staff to safely provide care and support to people. Checks were carried out on staff before they started work with people to assess their suitability. Medicines were well managed and people received their medicines as prescribed.

Staff received regular supervision and the training required to meet people's needs. The service complied with the requirements of the Mental Capacity Act 2005 which ensured people were involved in making every day decisions and choices about how they wanted to live their lives.

Arrangements were made for people to see healthcare professionals when they needed to. People were supported to have a healthy balanced diet and had access to the food and drink of their choice, when they wanted it.

People received a service that was caring and compassionate. They were cared for by staff that understood their needs and knew them well. Staff treated people with dignity and respect and were sensitive to their needs regarding equality, diversity and their human rights. The care and support people received was tailored to meet individual needs.

People's independence was promoted by staff who encouraged them to do as much for themselves as possible. People were supported to have maximum choice and control of their lives and staff supported them to make as many decisions as possible.

The service was well led. There was a clear management structure in place and staff understood their roles and responsibilities. The vision, values and culture of the service were understood by all staff, which they demonstrated when supporting people.

Staff consistently said they had received good support from the management team who were always available to give advice and guidance. The safety and quality of support people received was effectively monitored to drive continuous improvement of the service.

Further information is in the detailed findings below.

17 and 18 March 2015

During a routine inspection

This inspection of Request Services Limited took place on 17 and 18 March 2015 and was announced. The provider was given 48 hours notice of the inspection to ensure that the people we needed to speak with were available.

Request Services Ltd is a domiciliary care agency and provides personal care and support for

people living in their own home in North East Hampshire and West Surrey. At the time of our inspection there were 66 people using the service, who had a range of physical and health care needs, supported by 176 care staff. Some people were being supported to live with dementia, whilst others were supported with specific health conditions including epilepsy, diabetes, multiple sclerosis and sensory impairments. The agency also provides what is described as complex care for people who require specific and unique support, for example people with acquired brain injuries.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The service also has a complex care manager responsible for complex care provision, who was supervised by the registered manager.

At our previous inspection on 17 and 18 September 2014 the provider was not meeting legal requirements in relation to people’s care and welfare, supporting workers and assessing and monitoring the quality of the service. Following the inspection the provider sent us an action plan and informed us they would make improvements to meet these requirements by 31 December 2014. During this inspection we found the provider had taken necessary action and the required improvements had been made.

People using the service were actively involved in making decisions about their care and were asked for their consent before being supported. Relationships between staff and people were relaxed and positive. Care staff engaged with people to identify their individual needs and what they wanted.

Comprehensive risk assessments had been completed with people and where appropriate their relatives. Where risks to people had been identified there were plans in place to manage them effectively. Staff understood the risks to people and followed guidance to manage them safely.

The service responded flexibly to people’s individual wishes and changing needs and sought support from health and wellbeing specialists promptly when necessary. People’s dignity and privacy were respected and supported by staff. Care staff were skilled in using individual’s specific communication methods and were aware of changes in people’s needs. People were encouraged to be as independent as they were able to be, as safely as possible.

People told us they trusted the staff who made them feel safe. Staff had completed safeguarding training and had access to local authority guidance. They were able to recognise if people were at risk and knew what action they should take. People also had access to guidance about safeguarding in a format that met their needs, to help them identify abuse and respond appropriately if it occurred. The registered manager had taken action when people had been identified to be at risk and learning had taken place. People were kept safe as safeguarding incidents were reported and acted upon.

The registered manager completed a daily staffing needs analysis to ensure there were sufficient staff with the necessary experience and skills to support people safely. Whenever possible senior staff worked together with people, and where required their relatives, to identify in advance when their needs and dependency were likely to increase.

Staff were encouraged to undertake additional relevant qualifications to enable them to provide people’s specific and complex care effectively, and were supported with their career development.

The provider had established a training facility where care staff received thorough instruction from the provider’s nurse about how to support people’s unique complex care needs.

Robust recruitment procedures ensured people were supported safely by care staff with the appropriate experience, skills and character. The suitability of care staff to form caring relationships with people was assessed as part of their recruitment process. The provider frequently arranged additional care staff to that required to shadow colleagues providing complex care. This ensured that when regular care staff were unavailable the replacement care staff had previous experience of people’s needs and how they preferred their support to be delivered.

Medicines were administered safely in a way people preferred, by trained staff who had their competency assessed by the nurse and provider’s training specialist.

Staff had completed training on the Mental Capacity Act (MCA) 2005 during their induction process and understood their responsibilities. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to support people who do not have capacity to make a specific decision. Where people lacked the capacity to consent to their care, legal requirements had been followed by staff when decisions were made on their behalf.

The service has innovative and creative ways of training and developing care staff that makes sure they put their learning into practice to deliver outstanding care that meets people’s individual complex needs. The service works in partnership with other organisations to make sure they are training staff to follow best practice.

People’s needs in relation to nutrition and hydration were documented in their care plans. We observed people supported appropriately to ensure they received sufficient to eat and drink. Meals provided by care staff reflected people’s dietary needs and preferences. When necessary people had been referred to appropriate health professionals for dietary advice.

We observed friendly and relaxed interaction between people and care staff. People told us that when they had a problem or were worried they felt happy to talk with any of their care staff. Whenever people had raised concerns or issues, prompt action had been taken by the registered manager to address them to their satisfaction. Where complaints were made they were investigated and actions taken in response. Complaints were analysed to identify trends and themes. Where these had been identified action had been taken to make improvements.

Staff had received training in the values of the provider as part of their induction. People, their relatives and care staff told us the service was well managed, with an open and positive culture. People and care staff told us the registered manager and complex care manager worked as a team and were very approachable, willing to listen and made any necessary changes to improve the quality of care experienced by people.

The registered manager and senior staff provided good leadership and support to the care staff. They were involved in day to day monitoring of the standards of care and support that were provided to people.

18 March 2015

During an inspection of this service

17, 18 September 2014

During a routine inspection

The inspection team consisted of one adult social care CQC inspector. On the day of our inspection 65 people used the service. We spoke by telephone, with a total of 11 people who used the service or, where appropriate, their representative or family member. We also spoke with four care workers, the deputy manager and the registered manager. We reviewed records relating to the management of the home which included client visit records, incident records and staff training records. We looked at nine people’s care plans and records relating to staff supervision and appraisals. We viewed five records relating to people who received personal care, referred to as homecare clients, and four relating to people who received complex care.

New information of concern had been brought to our attention. This was in relation to the delivery of safe care to people, staff training, staffing levels, accuracy of people’s records, and monitoring of the quality of the service. We considered these concerns as part of our inspection.

We considered all the evidence we had gathered under the outcomes we inspected. We used this information to answer the five questions we always ask; is the service caring, responsive, safe, effective and well led?

This is a summary of what we found.

Is the service safe?

Some areas of the service were safe. People who use the service told us they felt safe when receiving personal care in their homes from the care workers. One person told us "I feel very safe and am confident in the care provided.” We found there were enough qualified, skilled and experienced staff to meet people’s needs safely.

We found the provider had systems in place to identify, assess and manage risks to people’s health, safety and welfare. The provider had reviewed people's risk assessments to reflect changes in their needs.

Is the service effective?

The service was effective in most areas. We found issues affecting people’s care and welfare had been identified, and appropriate measures had been implemented to improve people’s wellbeing. For example, accidents and incidents had been recorded and reviewed to ensure issues and trends had been identified, and actions taken to reduce the risk of repetition.

We found that all staff had been suitably supported to complete and refresh all mandatory training required by the provider. However, not all staff had attended an appraisal meeting. None of the staff had received regular individual supervisory meetings to discuss issues, concerns and aspirations to promote their development and understanding of their role and responsibilities. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to supporting staff.

People and relatives we spoke with were complimentary about the care received. One relative told us “The staff are very knowledgeable, they understand X’s needs.” Another relative said “They (the provider) are a very reliable and effective service.”

We found people’s care plans and other records relevant to the management of the service were accurate and fit for purpose. People’s records and confidential staff information were stored securely.

Is the service caring?

People were supported by kind and supportive staff. People and relatives told us that staff were very caring. One person told us “The care X(a staff member) provides is proper care. X actually cares about me.”

People told us the care workers gave encouragement when supporting them. People were able to do things at their own pace and were not rushed. One person told us “The team are very caring. They do not rush me.” Another person said “Staff let me do as much for myself as possible. They have helped me to have a normal life, to be more independent.”

The compliments folder we looked at recorded responses from people and their relatives. We saw feedback was positive. People rated staff support and care highly.

People told us they were always asked if they were happy with the care they were receiving when staff visited or during a review of their care plan. There were processes in place to ensure people and their relatives could provide feedback to the provider about the quality of the service received. Overall, where shortfalls or concerns were raised these were addressed.

Is the service responsive?

The service was responsive because relatives we spoke with confirmed they had been listened to and provided examples of improvements made to the service following their feedback. One person told us “They (the provider) are very flexible. They will change the visit times to meet my needs.” Another person said “I can speak to carers directly if I have any problems. I feel listened to because these problems are then resolved by the staff.”

We saw people’s and relative’s feedback was sought during quality spot check visits, regular telephone calls and surveys. We found the provider was responsive to comments from people.

People knew how to make a complaint and who to go to if they were unhappy. We looked at how complaints had been dealt with by the provider, and found that the responses had been thorough, and timely. People told us that when they had informed the provider of any concerns these had been addressed promptly, to their satisfaction.

Is the service well-led?

We spoke with people and their relatives who told us that they felt the service was well led. One person told us “This is a well led organisation. They are keen to make everything ok.” A relative said “This service is well led. Communications from the office are very good. ” People and their relatives told us they could speak with managers when they wished to, and stated that managers were approachable. The staff were very satisfied with the leadership and the management of the service. The registered manager and deputy manager were present at the service daily, and an on call service ensured 24 hour contact for staff if they had concerns or required management guidance.

Audits of the service had been completed to ensure that the quality of the service provided had been monitored and met the required standard. The provider did ensure the feedback of all people who used the service, their relatives and staff were regularly sought to improve the service. The provider showed us examples of actions taken in response to comments from people. This meant the provider had acted on feedback received from some people to improve the service.

However, we found the service was not always well led. This was because there was no system in place to monitor the actual duration of each staff visit to people’s homes. Monitoring was necessary to ensure actual visiting times reconciled with those identified as a requirement by the local authority and provider to ensure the care delivered met people’s identified needs. In three people’s records we looked at we noted occasions when staff visit times were actually less than the time identified as a requirement. This meant people may not have received all of the care required to meet their identified needs to ensure their health, safety and welfare.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to ensuring systems are in place to identify assess and manage risks relating to the health, welfare and safety of people that may arise from situations such as discrepancies between actual and required visiting times.

26 November 2013

During a routine inspection

During our inspection of Request Services Ltd. we found that people were asked for their consent before care or support was provided. Within the care plans maintained by the service people's consent had been recorded. One person who used the service told us, "The girls always tell me what they want to do and they make sure it's okay with me before they do it."

Following our inspection we spoke with people who used the service or a family member. We were told that the care received was of a high standard. One person said, "They are by far the best I have come across." Another told us, "They love my relative as if they were their own." However, we were told by two people that the office was disorganised and that on at least one occasion a member of care staff had failed to arrive as scheduled. One relative told us of two occasions when scheduled care visits had been missed. They said, "It wasn't too bad as I was here to cook lunch that day but it happened once before too." We found that care plans were, in some cases, incomplete or confusing.

Staff and people who used the service were protected from abuse.

Staff were supported through the provision of training and a programme of regular supervision and appraisal. One staff member told us "The managers and office staff give me good support".

The service monitored the quality of the service provided through questionnaires and face to face contact with people who used the service. They held regular staff meetings.

22 March 2013

During a routine inspection

At the time of this inspection the agency was providing personal care to 50 people and complex care to another 30 people.

We spoke by telephone with three people who used the service, three relatives of people who used the service and three members of staff. We spoke with two senior staff and the registered manager at the agency office.

People told us the service was very good. Their comments included; "The service is brilliant, the staff are like friends but they act professionally" and "The staff are very good I have no problems". The relatives we spoke with were equally positive about the service the agency provided for their family members'. They said, "The staff are excellent" and "The service is very good, they always treat my family member with respect".

People who used the service and their relatives were pleased that they usually had the same teams of staff visiting them and they knew the staff. People told us the staff usually arrived on time and they were usually informed if staff would be delayed.

People were aware of the care plans that recorded their needs. They told us they had been involved in planning and reviewing their care and agreeing to these plans. One person said "I was involved from the beginning in writing and updating my plan. One relative told us "They consulted me about my relatives needs".

People said they felt safe, they knew how to make a complaint and that communication with staff in the office was effective.